Biomedical subjects
Publications and source records attributed to R L Thatte.
A case of aglossia-adactyly syndrome with a sagittal band between the floor of the mouth and the palate is reported. The literature concerning this case is briefly reviewed. This case is being presented for its extreme rarity.
One of the drawbacks of Cecil-Culp urethroplasty for hypospadias is its failure to place the distal urethral meatus at the tip of the glans when the scrotal flap is detached. This paper describes a manoeuvre to overcome this drawback with the help of a small flap from the median raphe of the scrotum at the third and final stage of Cecil-Culp urethroplasty. Relevant illustrations from a case and line drawings are included to describe the procedure. A small note is appended as a comment.
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This paper includes material which is a follow-up on the work of Se Min Baek et al. (1985) who demonstrated that in dogs a saphenous flap could survive without arterial inflow. Here we have repeated part of their work and confirmed it. In addition, this paper shows that in dogs a saphenous venous flap with only the cephalad venous channel intact can survive even if the vein is cut and replaced by a non-biological conduit (a polyethylene tube). A total of 13 dogs and 19 flaps were studied. The possible reasons for the survival of these flaps are discussed.
A case is reported in which an island fasciocutaneous flap from the radial side of the forearm, with only the cephalic vein connecting it to the rest of the body (Fig. 1) was successfully transposed to cover part of a defect on the ulnar side of the elbow. An earlier case in which such a venous flap was raised but not used for cover is also detailed. A brief discussion speculating on the way this flap survived without any arterial inflow and only proximal venous drainage is included.
The superficial external pudendal artery (SEPA) flap was described by Dias in 1984. This paper describes the anatomical foundation of the flap, based on dissections of 12 cadavers and clinical findings in patients undergoing surgery in the groin and lower abdomen. The artery was found to be adequate in calibre and length to sustain a skin flap, on either side of the midline, extending from the symphysis pubis to the umbilicus.
A series of 30 cases is presented in which the SEPA flap was used to provide skin cover for injuries and defects in the hand and fingers. Our experience with both unilateral and bilateral SEPA flaps confirms their reliability, convenience and versatility. The SEPA flap design can be used in conjunction with other flaps and in itself contributes to a more rational use of the skin of the lower abdomen in reconstructive surgery.
An unusual congenital anomaly of a bilateral complete cleft of the primary palate, a complete cleft of the left secondary palate with abnormal nostrils without external openings and right choanal atresia is presented. The child also has a lachrymal fistula below the right lower eyelid and a coloboma of the same eyelid medially. Neither lachrymal system drained into the nose.
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It is not easy to provide skin cover simultaneously to both the dorsal and the volar surface of an injured hand. A case is reported in which the dorsum of the hand was covered by a superficial external pudendal artery (SEPA) axial pattern flap (Dias, 1984) and the volar surface by a flap fashioned from the anterior rectus sheath, which in turn was covered with a split-skin graft. A good result was obtained.
A series of 10 patients is presented in whom cross-leg fasciocutaneous flaps were detached on the tenth day without any subsequent complication or loss. All the flaps were designed with a distal fascial extension that might have helped neovascularisation of the flap. The paper also includes a description of the nature of the fasciocutaneous flap in the leg, comments on the neovascularisation of flaps and a brief analysis of the economics of a skin flap transfer.
This paper describes a technical manoeuvre to accommodate an exposed metal implant used in the treatment of a fracture of the tibia within a "turn-over" de-epithelialised fasciocutaneous flap. The need for such a procedure in this particular case is commented upon. A discussion is also included on the nature of the blood supply to the integument based on available information.
A simple non-invasive technique has been used to study the dimensions of the ischial pressure point in normal and paraplegic individuals. The same technique charts the surface area of the gluteal impression. The data obtained in these two groups of patients (normal and paraplegic) have been analysed to see if it is possible to predict the greater susceptibility of certain individuals to suffer from pressure sores over the ischial tuberosity.
In two patients we have used the fascia of the lower leg as a roll-over flap to heal defects of the skin and subcutaneous tissues. The case reports are preceded by the description of an experimental anatomical model to illustrate the attachments, blood supply and the potential range of movement of the fascia of the medial intermuscular compartment of the leg. The rationale for the procedures that were performed and the problems encountered are discussed.
This is a follow-up report on an earlier paper (Thatte, 1981) in which the idea of radical mobilisation of the orbicularis oris muscle in the treatment of unilateral cleft lip was presented. This paper includes eight late post-operative photographs of cases with unilateral cleft lip treated by radical mobilisation of muscle and suture without any recourse to incisions in the philtral area to gain height on the non-cleft side. Legends for the post-operative photographs describe our assessment of the results. Observations made while operating on these cases are noted. A discussion is included to view the manoeuvre of mobilisation of muscle against the background of existing methods of treatment of unilateral cleft lip. A postscript is added.
Full-thickness loss of a part of a skin flap may produce a serious residual defect that needs additional flap cover. A de-epithelialised "turn-over" skin flap (Thatte, 1981; Mahler and Yanai, 1981; Thatte, 1982) fashioned from the surviving adjacent flap skin, can provide a simple solution to these residual defects. The same technique can also be effectively employed where a skin flap of inadequate dimensions has been transferred to an area resulting in a defect or a deformity due to skin shortage. Two representative cases are presented and the merits of the technique are discussed.
Leonard (1981) has reported the successful use of a de-epithelialised "turn over" deltopectoral flap for a chest wall defect. This paper presents the application of the principle of a de-epithelialised " turn over" type of flap to the fasciocutaneous flap described by Pontén (1981) and the dorsalis pedis flap described by O'Brien and Shanmugam (1973) and McCraw and Furlow (1975) for defects of skin and subcutaneous tissue in the lower extremity. The reason for their choice and the alternatives are briefly discussed and some general comments are added on the use of de-epithelialised "turn over" flaps.